R F Lavery

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Among patients who underwent surgery for traumatic cervical spine fractures, 30% developed severe swallowing problems that required a feeding tube placed directly into the stomach. Patients who also needed a breathing tube (tracheostomy) were especially likely to need a feeding tube—83% of them did—yet half of those patients waited an average of 9 extra days before getting one. Earlier feeding tube placement, particularly for tracheostomy patients, would improve nutrition, reduce complications, and speed discharge.

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About 13% of trauma patients with ventilator-associated pneumonia also had matching bacteria in their bloodstream—a condition called bacteremia-VAP. These patients received far more blood transfusions, stayed in the ICU twice as long, and nearly 70% had additional simultaneous infections elsewhere in the body. Trauma patients with this combination should be screened for hidden infections throughout the body and may benefit from broader antibiotic coverage from the start.

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Over 12 years, one Level I trauma center treated 6,322 gunshot wound patients, and the injuries grew more severe over time—more wounds per patient, more body regions hit, and mortality rising from 9% to 14%. The violence was not random: five cities accounted for 85% of cases, and 70% of victims were shot within a mile of their own home. Total inpatient costs hit $115 million, with 75% unreimbursed, and trauma registry data missed nearly one in five patients, meaning the true burden of gun violence is substantially underreported.

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A review of 1,297 trauma patients who underwent emergency abdominal surgery found that obesity, despite being associated with longer hospital stays and more infectious complications, was not an independent predictor of death or major morbidity once other injury factors were accounted for. The study compared outcomes across four body mass index categories and found no difference in injury severity or death rates. Obese trauma patients should receive the same aggressive care as other patients rather than being considered inherently higher-risk.

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A pedestrian safety education program taught annually to over 1,500 elementary school students improved short-term knowledge test scores across all grades, but actual safety behavior on real streets barely changed—only 8% of observed children looked left-right-left before crossing. Children in third and fourth grade showed some long-term knowledge retention, but younger children's scores fell back to baseline each year. Teaching children road safety facts is not enough; programs need to change real-world behavior, and annual single-session education appears insufficient to do that.

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This study examined whether men and women differ in how their blood sugar fluctuates after severe trauma, and whether those fluctuations predict survival. In a cohort of nearly 2,000 trauma patients, blood sugar instability in men strongly predicted death, while the same measure in women did not. The results suggest that standard glucose management protocols designed around studies predominantly involving male patients may be less applicable to female trauma patients.

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Researchers followed up 100 trauma patients who had survived ICU stays of at least 10 days, an average of 3.3 years after discharge. While 92% were living at home, only 49% had returned to work or school, and 70% described themselves as less active than before their injury. Survival after severe trauma is not the same as recovery, and trauma center success should be measured by patients' return to productive life, not just whether they leave the hospital alive.

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CT scans detected rib fractures far more often than chest X-rays—standard X-rays missed fractures in more than half of patients—but despite this improved detection, the X-ray finding of any visible rib fracture or lung bruising was actually a better predictor of which patients would develop respiratory failure. Fractures spread across multiple areas of the chest doubled the risk of respiratory failure. Radiology reports frequently misdescribed or miscounted fractures, and relying on those reports for clinical decisions will lead to errors.

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Researchers studied over 4,000 trauma patients to see how men and women's bodies responded differently to serious injuries. They found that women of childbearing age (14-54 years old) recovered better than men with similar injuries—their bodies showed better blood circulation and tissue oxygen delivery, even though their injuries were often more severe. This matters because it means doctors may need to adjust how they treat men and women differently after major trauma, and it confirms that the hormones in younger women give them a biological advantage in surviving shock and severe injury.

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A randomized clinical trial tested whether adding ipratropium bromide to continuous nebulized albuterol improved outcomes for adult emergency department patients with acute asthma. Neither lung function improvement at 60 or 120 minutes nor hospital admission rates differed between the combination group and the albuterol-only group. For patients treated with continuous rather than intermittent nebulization, adding ipratropium bromide provides no extra benefit.

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Trauma patients showed early blunting of their neutrophils' ability to respond to chemical signals that guide immune cells to sites of infection, with the CXCR2 receptor being most severely affected. This suppression was worst immediately after injury and typically resolved within a week, but 44% of the study patients developed pneumonia during that window. Impaired CXCR2 function in the first days after trauma appears to be a biological mechanism that increases infection risk before the immune system rebounds.

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A multicenter prospective trial followed 236 isolated traumatic brain injury survivors for one year and found that age was the dominant factor in recovery. Patients over 60 improved the least—only 37% made further gains after discharge compared to 63–85% in younger groups—while patients aged 18–29 had the worst initial scores but achieved the best functional outcomes at one year. The data show that recovery potential from brain injury diminishes with age and that differences begin appearing even in the 45–59 age group.

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A review of 298 gunshot wound patients with head injuries found an overall in-hospital mortality of 51%. The strongest predictors of death were respiratory arrest on arrival, low blood pressure, and bullets that crossed from one side of the brain to the other or passed through the fluid-filled ventricles. Even patients arriving with a Glasgow Coma Scale of 3—the lowest possible score—had seven survivors to discharge, which argues against automatically withholding treatment based on any single measurement.

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In 151 patients with minor head injuries and abnormal CT scans who remained neurologically normal or improved, not a single patient required brain surgery after a routine repeat CT scan at 24 hours. A stable or improving neurological exam appears to make the follow-up scan unnecessary in this group. Eliminating routine repeat scans in these patients would reduce radiation exposure, cost, and resource use without putting patients at risk.

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A multicenter study of 235 mild-to-moderate traumatic brain injury patients found that while elderly survivors (65+) had less severe initial injuries than younger patients, they still had worse functional independence scores at both discharge and 6 months. Older patients were more often sent to rehabilitation and consistently trailed younger patients in recovery, though both groups continued improving during the first 6 months. The results support aggressive treatment of elderly TBI patients rather than therapeutic pessimism, while highlighting that age meaningfully shapes recovery trajectory.

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A prospective study of 222 high-risk trauma patients showed that CT scans of the chest, abdomen, and pelvis—already performed to look for internal organ injuries—detected spinal fractures with 99% accuracy, compared to 87% for dedicated spine X-rays. The CT missed no fractures at all and cleared spinal precautions faster. In trauma patients already getting a CT scan of the torso, separate spine X-rays are unnecessary and should be replaced by the CT results.

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A 10-year review of 116 male patients with traumatic injuries to the external genitalia found that 75% required surgery, with a testicular salvage rate of only 39% due to the high proportion of gunshot wounds (79% of cases). The American Association for the Surgery of Trauma injury grading system reliably identified which injuries needed surgery and which could be safely managed without an operation. Using this standardized grading system gives surgeons a practical framework for treatment decisions in these uncommon injuries.

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A prospective study of 145 patients in acute pain found that 95% could accurately read their own score on a visual analog pain scale within 2 millimeters of physician measurements. This simple finding validates using the instrument for patient self-reporting outside of clinical visits, such as in home monitoring of chronic pain or longitudinal research studies.

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Among 37 liver injury patients who underwent catheter-based embolization to stop bleeding, the procedure was technically successful but associated with substantial complications in survivors—58% developed liver-related problems including dead tissue, abscesses, and bile leaks. Patients who received embolization early, before any liver surgery, needed fewer blood transfusions and more often had sterile fluid collections rather than infected ones. Embolization is a valuable tool for severe liver injuries but patients must be closely monitored for serious post-procedure complications.

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A five-year review at two Level I trauma centers found that elderly patients (65+) with isolated brain injuries died at twice the rate of younger patients—30% versus 14%—even when their initial brain injury scores suggested milder damage. Functional outcomes at discharge were also significantly worse for older patients. Age itself, independent of injury severity or complications, is a powerful predictor of death and poor outcome after traumatic brain injury.

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A statewide survey found that 85% of mobile intensive care units had changed their prehospital medication storage practices after prior research showed drugs were being stored outside safe temperature ranges, with most changes driven by new state regulations. Currently, 63% of vehicles have both heating and cooling devices dedicated to medications, and 94% monitor temperature in some way. This study demonstrates that research findings, when translated into regulation, can meaningfully change real-world emergency medical practice.

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A review of 216 autopsies following trauma deaths found no major diagnostic errors that would have changed outcomes—errors that standard quality-assurance peer review had already identified or deemed nonpreventable. Only one potentially technical error was found that peer review had considered nonpreventable. In a mature trauma program with rigorous peer review, mandatory autopsies add little useful clinical information and autopsy rates are a poor measure of quality.

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A 22-month prospective study of 2,299 blunt abdominal trauma patients found that free fluid on CT scan without visible organ injury was present in 90 patients, and only 7 of them (8%) had an intestinal injury. All patients were safely monitored without emergency surgery, with no missed injuries. Mandatory surgery for everyone with unexplained free fluid on CT is not justified; careful observation is appropriate for the vast majority.

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Blood samples taken within 12 hours of major trauma showed that the CXCR2 receptor on immune cells behaved in opposite ways depending on what complications later developed: patients who went on to develop ARDS had high CXCR2 activity, while patients who later developed sepsis or pneumonia had abnormally low activity. CXCR1 activity was lower in all trauma patients but didn't separate outcomes. A simple measurement of CXCR2 activity shortly after injury may help predict whether a patient is heading toward immune overactivation or immune failure.

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This article describes capnography—continuous monitoring of exhaled carbon dioxide—as a valuable tool for air medical transport teams to confirm correct breathing tube placement and monitor ventilation in critically ill patients. The device provides real-time feedback that helps clinicians optimize breathing support during transport when reassessment is difficult. Its use addresses one of the highest-risk procedures in emergency transport: ensuring an endotracheal tube is in the right place.

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This report describes a collaborative model in which trauma center physicians, nurses, and paramedics provided direct on-site medical support for FBI SWAT operations in Newark, NJ. Over the program's first years, the team covered 33 tactical missions and 99 training days, treating 10 patients. The model demonstrates that trauma center expertise integrated into tactical law enforcement operations can provide high-level emergency care at the point of injury rather than waiting for transport.

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A prospective study of 2,152 minimal head injury patients found that a negative CT scan—interpreted as showing no intracranial injury—had a negative predictive value of 99.7% for the need for neurosurgical intervention. Only one patient with a negative CT ultimately required a procedure, and that was for facial fractures, not brain injury. Patients with a clean CT and no persistent neurological symptoms can be safely sent home from the emergency department, potentially eliminating more than 500,000 unnecessary hospital admissions per year.

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A study of 375 trauma patients found that blood lactate drawn from a vein correlates almost perfectly with arterial lactate (r = 0.94), making the simpler venous draw a reliable substitute. A venous lactate level at or above 2 mmol/L cut undertriage of seriously injured patients in half compared to standard triage criteria and reduced overtriage by 28%. Venous lactate is a fast, practical tool that could significantly improve how trauma patients are sorted and prioritized on arrival.

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A national survey of 138 air medical programs found wide variation in infection control practices, with fire-based programs more likely to require pre-employment screenings and immunizations than non-fire-based programs. While 88% had formal decontamination policies, only 70% had OSHA-compliant filter masks available. Standardizing infection control programs across air medical services, with full adherence to standard precautions, is needed to protect crew members from occupational exposure to infectious disease.

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A prospective multicenter trial of 2,299 blunt abdominal trauma patients found that CT scanning had a negative predictive value of 99.6% for the need for abdominal surgery. Abdominal tenderness—present in 61% of patients—predicted a positive CT scan only 22% of the time, showing physical exam alone is unreliable. Patients with a negative abdominal CT scan do not need hospital admission for observation and can be safely discharged from the emergency department.

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A national telephone survey of 77 air medical programs found that 45% required administrative approval and 31% required medical approval before accepting an interhospital transfer mission. Most programs transferred patients to facilities beyond their home hospital, and the majority required some form of authorization before accepting those missions. As managed care increases scrutiny of air medical resource use, programs need transparent, consistent screening policies to balance patient access with appropriate utilization.

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A portable handheld lactate analyzer tested against a laboratory reference instrument on 66 blood samples from 47 trauma patients showed very high correlation (r² = 0.98) across clinically relevant lactate values. The device performed accurately when operated by medical students and physicians in a trauma center setting. Point-of-care lactate testing can provide this important injury severity marker immediately at the bedside rather than waiting for laboratory results.

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Fluid collected directly from fracture and soft tissue injury sites suppressed natural killer cell immune activity more rapidly and potently than blood from the same patients, with the suppression strongest in the first 1–4 days after injury. Adding interleukin-12 restored natural killer cell function, while neutralizing antibodies to anti-inflammatory cytokines made suppression worse. Local cytokines concentrated at injury sites may be a primary driver of the immune dysfunction that leaves trauma patients vulnerable to infection.

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A comparison of helicopter versus ground transport of pediatric trauma patients found no difference in injury severity between the two groups, unlike adults where helicopter patients are consistently more severely injured than ground-transported patients. This suggests that field crews are less selective about flying children than adults, likely because standard trauma triage criteria were developed for adults. Pediatric-specific triage protocols are needed to ensure helicopter resources are used appropriately for injured children.

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A prospective randomized prehospital asthma trial used online physician medical command to assign treatment groups, enrolling 87 of 136 eligible patients with 100% safety—no enrolled patient met any exclusion criteria. The approach allowed real-time eligibility verification and blinded randomization conducted by paramedics in the field. Physician-supervised online medical command is a safe and effective method for conducting rigorous randomized trials in the prehospital setting.

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Paramedics in a moving urban ambulance measured systolic blood pressure using pulse oximetry waveform—observing when the waveform reappeared during cuff deflation—and found it correlated with auscultation (r = 0.95) and palpation (r = 0.97) at the hospital. This technique is fast and accurate even in noisy, moving vehicles where conventional methods are unreliable. Pulse oximetry blood pressure measurement offers a practical alternative for field providers who struggle with auscultation in difficult prehospital conditions.

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A retrospective comparison of helicopter transports carrying one versus two patients found that the second patient on a multi-patient mission was almost never as severely injured as the average single-patient transport, with most patients requiring few or no in-flight procedures regardless of transport type. No difference in neurological status during flight was found between the two groups. Reducing the crew-to-patient ratio during dual-patient transports does not compromise care because the workload is inherently lower in these missions.

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A prospective study in moving ambulances found that a handheld whole blood analyzer produced results for electrolytes, glucose, blood urea nitrogen, and hematocrit that correlated highly with hospital emergency department values obtained minutes later (r values 0.89–0.99). Paramedics reliably operated the device under field conditions without compromising precision. Real-time blood chemistry data in the field could help physicians make more objective triage decisions about where to send patients before they arrive at a hospital.

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A computer modeling study of 167 helicopter transport missions found that requiring on-scene paramedics to first contact a physician for authorization before calling a helicopter significantly lengthened the time to reach a trauma center, particularly in suburban and rural areas. First responders requesting a helicopter on arrival—without waiting for physician authorization—provided the fastest transport times in all but urban settings. The study argues that who is allowed to call a helicopter, not just whether to use one, directly affects how quickly severely injured patients get definitive care.

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A retrospective review of 913 trauma patients found that while 89% had at least one abnormal serum chemistry value on admission, only 6% had values critical enough to matter clinically, and only six patients had treatment actually changed based on those results. Older patients, those with hypertension history, and patients with low neurological scores were most likely to have truly critical chemistry values. Routine chemistry panels for all trauma patients waste resources; selective ordering based on clinical criteria is a more rational approach.

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A national survey of 165 urban advanced life support systems found that emergency medicine physicians direct 77% of them, most are paid for their EMS work, and their involvement is concentrated in quality assurance and education rather than administrative or executive functions. The number of medications carried or procedures approved was unrelated to how many hours the medical director spent on EMS activities. EMS medical directors primarily serve as clinical and educational resources, with limited roles in organizational management outside of fire-based systems.

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A prospective review of 236 prehospital intubation attempts found an 88% overall success rate, with the level of consciousness being the only statistically significant predictor of failure—awake or combative patients were harder to intubate. Paramedics reported difficulty in nearly half of attempts, most often from technical problems and poor visualization. The findings support expanding use of paralytic agents in the field for combative patients and regular hands-on training to maintain intubation skills.

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A randomized prehospital trial of 154 adult asthma patients found that subcutaneous epinephrine, nebulized metaproterenol, and the combination of both produced equivalent improvements in lung function with no significant differences in vital sign changes or adverse effects. Neither combining the two drugs nor choosing one over the other provided a clinical advantage. Paramedics can use either drug alone for field asthma treatment without losing effectiveness.

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A prospective cohort study found that 7.4% of patients who underwent emergency abdominal surgery for penetrating trauma developed small bowel obstruction within 6 months, with rates highest (10.8%) in patients with bowel injuries. Prior abdominal surgery was not a risk factor in this population, contrary to general surgical experience. Patients with penetrating abdominal trauma—especially those with bowel injuries or gunshot wounds—need close follow-up for this common post-operative complication.

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A national survey of 88 urban EMS systems found 81 serious disabling injuries requiring hospitalization over the study period, most commonly to the hand, head, foot, and eye. Fire-based EMS systems provided safety equipment to over 90% of providers, while fewer than half of non-fire-based systems did so. EMS medical directors—especially in non-fire systems—must take a stronger role in ensuring frontline providers have adequate protective equipment for a job with genuine occupational injury risk.

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A two-year review of 458 pediatric ALS trauma calls in an urban EMS system found that violence accounted for 46% of injuries—more than vehicle accidents—with a male predominance. Intravenous line placement succeeded 93% of the time and intubation 79% of the time, with field times only slightly longer for ALS responses versus basic life support. The study proposes benchmark standards for prehospital pediatric trauma care and highlights that urban pediatric trauma is dominated by violence, not accidents.

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A prospective multicenter study of 181 prehospital blood samples found that glucose reagent test strips correctly identified 94% of hypoglycemic patients in the field, with only two false negatives—both with glucose values well above the danger threshold. Using a cutoff of 90 mg/dL instead of 60 mg/dL raised sensitivity to 100% at the cost of more false positives. Glucose test strips are a practical and sufficiently accurate tool for paramedics to screen for hypoglycemia in the field.